Welcome to my blog. HIV prevalence is not a reliable indicator of sexual behavior because the virus is also transmitted through unsafe healthcare, unsafe cosmetic practices and various traditional practices. This is why many HIV interventions, most of which concentrate entirely on sexual behavior, have been so unsuccessful.

Monday, May 28, 2012

I would like to make some clarifications to yesterday's blog after receiving comments on Twitter. I am not opposed to the use of vaccines, especially for diseases like polio. But there are too many diseases to line up vaccines, one by one, for each remaining disease. And all the time vaccine programs are going on, people are drinking contaminated water, sewage is being dumped in the water supply, nutrition levels are low, etc. Vertical health programs, tackling one disease at a time, is not the best way of approaching deadly diseases. And health is not just an array of diseases to be 'fought' with various different pharmaceutical products. Think of it this way; we don't have cures for many diseases but we do know that where living conditions are terrible, disease burden will be high.

Gates is in favor of vertical programs and is using the example of polio vaccination, which has been going on for decades, slowly eradicating the disease in one country after another, to push for the same approach to other diseases. Some of these other diseases might better be addressed by spending more on provision of clean water and sanitation or nutrition or a combination of measures. But his aim is to spread technology (drugs, GMOs, geoengineering, birth control, etc), not to ensure high levels of health. The amount of time, money and effort spent on polio eradication is worthwhile; but if the same amount of time, money and effort were spent on water and sanitation, the need to spend time on vaccinations for each serious water-borne disease would be reduced considerably.

The authors briefly raise the issue of intense competition being involved in such programs, which can strongly influence critical analysis; also the "conflation in medical journals of fine-grained and detailed scholarly research (undertaken mainly by parasitologists and epidemiologists) with broad assertions that are best understood as advocacy statements", an example of which may be found in a recent post on this blog (though much of the conflating was done by the lead author of the article); and the authors call for insights from social scientists not to be dismissed, as they so often are. They feel that current efforts will not be sustainable and will not 'make poverty history', as the popular slogan has it.

Gates and others seem to take a kind of scorched earth approach to health and development, as if money and technology are weapons. But what is worse, they seem to think of people suffering from diseases, or at risk of those diseases, as the enemy, to have various techniques and technologies shoved down their throat (or elsewhere), whether they like it or not. The latent contempt and violence behind mass male circumcision and the highly aggressive marketing of Depo Provera and various birth control methods are obvious enough to some, but other health (and development) programs also need to take into account the recipients, not just those who have decided who the recipients should be.